Local vascular complications after use of the hemostatic puncture closure device Angio-Seal

BACKGROUND: As an alternative to manual pressure techniques new systems for achieving arterial hemostasis after cardiac catheterization were developed. Here we report about the diagnosis and therapy of femoral artery complications after use of the closure device Angio-Seal, consisting of an intraarterial anchor and extravascular collagen plug. PATIENTS AND METHODS: Angio-Seal was deployed in 350 patients undergoing cardiac catheterization. Vascular investigations after device application consisted of ankle/brachial-pressure-index measurement, duplex sonography, and angiography. RESULTS: Vascular complications occurred in 10 of 350 patients. In two patients complete occlusions of the superficial femoral artery required immediate vascular surgery. Stenoses of the superficial (five patients) and the common (three patients) femoral arteries were diagnosed in 8 cases. Of these 10 patients eight were obese, in 2 cases there was a further catheterization with Angio-Seal device application via the same femoral approach. Until now six patients underwent successful surgery: in 4 cases the whole Angio-Seal device was located intraarterially, there was 1 case of intima-dissection, and 1 case remained unclear due to a diagnostic delay of 7 months. In three patients with stenoses of the common femoral arteries without hemodynamic relevance no therapy was required. CONCLUSIONS: Occlusions or stenoses of femoral arteries after use of Angio-Seal can be diagnosed easily by duplex sonography. All hemodynamic relevant complications (n = 7 of 350 [2%]) concerned a puncture of superficial femoral arteries. In these patients vascular surgery seems to be an adequate therapy.     

Closure of the femoral vein puncture site after transcatheter procedures using Angio-Seal.

The use of anchor-based, collagen-derived vascular sealing devices in femoral vein punctures during right and left heart catheterizations or coronary interventions necessitating venous access for temporary pacemaker or hemodynamic monitoring has not been studied. We hypothesized that using these devices in the femoral vein would be practical and reliable. One hundred and ten consecutive patients undergoing right and left heart catheterization (56 patients, 51%) or coronary intervention (54 patients, 49%) were included in this study. Forty-five of the interventions received IIb/IIIa inhibitors in combination with heparin, enoxaparin, aspirin, and clopidogrel. The Angio-Seal device was successfully deployed in the femoral vein in all patients, whereas 93 (85%) received arterial Angio-Seal, 8 received Perclose, and 9 (8%) had manual pressure or a Fem-Stop applied to control arterial bleeding after deployment. We conclude that in patients undergoing transcatheter procedures requiring venous access, the use of an 8 Fr Angio-Seal to seal the femoral vein is safe and feasible.     

Early clinical experience with the 6 French Angio-Seal device: immediate closure of femoral puncture sites after diagnostic and interventional coronary procedures.

The objective of this study was to assess the early safety and efficacy of the novel 6 Fr Angio-Seal device for routine clinical use after diagnostic cardiac catheterization and coronary angioplasty. In a prospective study, we used the 6 Fr Angio-Seal device in 180 consecutive patients (131 male, 49 female, mean age 60.7 years) for closure of femoral arterial puncture sites immediately after diagnostic (n = 108) or interventional (n = 72) coronary procedures independent of the coagulation status. All patients were monitored for 24 hr after the procedure and followed for 30 days. The closure device was successfully deployed in 95.4% after diagnostic catheterization versus 98.6% after coronary angioplasty (P = 0.963). Immediate hemostasis was achieved in 91.5% versus 90.1% of the patients (P = 0.993). Major complications were observed 1.9% versus 2.8% of the patients (P = 0.885). During 30-day follow-up, no late events or complications were reported. The 6 Fr Angio-Seal device is a safe and effective device that allows for immediate closure of femoral puncture sites after both diagnostic and interventional procedures with a low rate of major complications.     

新型血管封堵器在心导管术后应用120例观察

目的评价新一代血管封堵器Angio-Seal STS在冠状动脉造影及介入术后股动脉封闭中的应用价值。方法对重庆医科大学附属第一医院心内科2004-09—2005-12收治的298例病人,分为血管封堵器A组(120例)和人工压迫B组(178例),观察止血成功率、止血时间、卧床时间及血管性并发症。结果A组在止血时间、卧床时间及腰背痛不适上明显低于B组(P<0·05)。在止血成功率、腹股沟皮下血肿及血管迷走神经反射方面两组差异无显著性(P>0·05)。结论Angio-Seal STS血管封堵器对股动脉穿刺点能快速、有效地止血,缩短卧床时间,且不增加血管性并发症。Angio-Seal STS特点是自身紧闭式缝合,无须已往使用Angio-Seal后放置的弹簧。     

Potentiation of cocaine-induced coronary vasoconstriction by beta-adrenergic blockade

STUDY OBJECTIVE: To determine whether beta-adrenergic blockade augments cocaine-induced coronary artery vasoconstriction. DESIGN: Randomized, double-blind, placebo-controlled trial. SETTING: A cardiac catheterization laboratory in an urban teaching hospital. PATIENTS: Thirty clinically stable patient volunteers referred for catheterization for evaluation of chest pain. INTERVENTIONS: Heart rate, arterial pressure, coronary sinus blood flow (by thermodilution), and epicardial left coronary arterial dimensions were measured before and 15 minutes after intranasal saline or cocaine administration (2 mg/kg body weight) and again after intracoronary propranolol administration (2 mg in 5 minutes). MEASUREMENTS AND MAIN RESULTS: No variables changed after saline administration. After cocaine administration, arterial pressure and rate-pressure product increased; coronary sinus blood flow fell (139 +/- 28 [mean +/- SE] to 120 +/- 20 mL/min); coronary vascular resistance (mean arterial pressure divided by coronary sinus blood flow) rose (0.87 +/- 0.10 to 1.05 +/- 0.10 mm Hg/mL.min); and coronary arterial diameters decreased by between 6% and 9% (P less than 0.05 for all variables). Subsequently, intracoronary propranolol administration caused no change in arterial pressure or rate-pressure product but further decreased coronary sinus blood flow (to 100 +/- 14 mL/min) and increased coronary vascular resistance (to 1.20 +/- 0.12 mm Hg/mL.min) (P less than 0.05 for both). CONCLUSIONS: Cocaine-induced coronary vasoconstriction is potentiated by beta-adrenergic blockade. Beta-adrenergic blocking agents probably should be avoided in patients with cocaine-associated myocardial ischemia or infarction.     

肝衰竭患者深静脉置管的选择

目的:探讨肝衰竭患者理想的深静脉置管方式.方法:肝衰竭患者根据病情选择不同深静脉置管方式,观察患者发生血肿、穿刺点渗血、瘀斑、导管感染等并发症发生率.结果:股静脉穿刺瘀斑发生率明显高于颈内静脉(P＜0.01);颈内静脉穿刺点渗血明显高于股静脉(P＜0.01);动脉损伤发生率股静脉穿刺高于颈内静脉(P＜0.05).同一患者颈内静脉穿刺点发生渗血高于股静脉(P＜0.05),股静脉的瘀斑发生率高于颈内静脉(P＜0.001).结论:颈内静脉是肝衰竭患者最安全、最常用的深静脉置管位置,当进行血液净化、血浆置换等治疗时,股静脉可以作为置管首选方式.     

Percutaneous closure after inadvertent subclavian artery cannulation.

Accidental insertion of an arterial sheath is an uncommon but potentially serious complication of jugular venous catheterization. When the subclavian artery is inadvertently cannulated, sheath removal can be complicated by significant hemorrhage due to its incompressible location. We report a case of inadvertent insertion of an 8 French sheath into the subclavian artery, which was successfully removed and the puncture site sealed with a collagen-based vascular closure device (Angio-Seal STS Plus). This averted an otherwise emergent open surgical procedure to remove the sheath and repair the subclavian artery in a high-risk patient.     

Timing and interpretation of the hemodynamic effects of the pneumatic antishock garment

STUDY OBJECTIVES: To clarify apparently conflicting reports on the hemodynamic effects of the pneumatic antishock garment (PASG). DESIGN: Ten anesthetized dogs with hemorrhagic hypotension had hemodynamics measured without PASG inflation (group 1) and were compared with ten dogs with PASG inflation (group 2). MEASUREMENTS AND MAIN RESULTS: Baseline and immediate posthemorrhage data were similar in both groups. Group 1 maintained a carotid artery pressure of 85 +/- 9 mm Hg while group 2, by design, maintained baseline CP at 119 +/- 12 mm Hg. After PASG inflation, carotid artery flow increased by 50%, and femoral artery flow decreased tenfold. There was an immediate but transient increase (2.4 +/- 0.1 to 2.7 +/- 0.1 L/min, P less than .05) and a later decrease in cardiac output to 1.9 +/- 0.9 L/min and an increased pulmonary artery wedge pressure and central venous pressure over one hour. Saline (342 +/- 12 mL) reversed the decreased cardiac output without changing pulmonary artery wedge pressure or central venous pressure. CONCLUSION: PASG inflation, therefore, not only increases venous return and cardiac output initially by compressive venous emptying but also decreases venous return and cardiac output later by further venous compression without cardiac decompensation. Thus, apparently conflicting data are explained by the timing and interpretation of the raw hemodynamic measurements.     

两种不同方式复制大面积肺栓塞动物模型的比较

目的 比较自制可脱落球囊和自体血凝块行大面积肺动脉栓塞动物模型的异同.方法 健康绵羊18例,随机分为3组:血栓栓塞组(简称血栓组)、球囊栓塞组(简称球囊组)和空白对照组.所有动物均经全麻下监测有创肺动脉压、中心静脉压及外周动脉压.使用12 F薄壁指引导管置于右肺动脉,将自制可脱落球囊或自体血凝块经导管引入,建立肺栓塞动物模型.分别于栓塞术前、肺栓塞模型建立后0.5 h、1 h、2 h、4 h、6 h及8 h监测平均动脉压(MAP)、平均肺动脉压(MPAP)、心率、呼吸频率及外周血氧饱和度(SaO2),动脉血氧分压(PaO2)和动脉血二氧化碳分压(PaCO2).结果 2组建立大面积肺栓塞模型的绵羊均在注入自体血栓或球囊阻塞后经肺动脉造影证实为右侧肺栓塞.实验动物均存活8 h以上.动物模型建立后0.5 h～2 h出现心率、呼吸频率加快,SaO2及PaO2下降,肺动脉压增高,与空白对照组比较差异有统计学意义,但2种栓塞方法间对照差异无统计学意义.2 h后逐渐稳定,球囊组呼吸指标缓慢回升,血栓组则稳定于较低水平,球囊组与血栓组对照有统计学差异.结论 球囊栓塞较好的模拟肺栓塞的机械作用,血凝块较好的模拟血栓中活性物质的影响,可根据实验目的的不同而选择不同的模型复制方式.     

Increased circulating endothelin-1 in rheumatic mitral stenosis: irrelevance to left atrial and pulmonary artery pressures

BACKGROUND: Increased plasma endothelin (ET)-1 concentrations have been observed in patients with rheumatic mitral stenosis (MS). However, the mechanisms of increased circulating ET-1 in patients with MS remain unclear. METHODS: We measured plasma concentrations of ET-1 in blood samples from the femoral vein and artery, and right and left atria obtained from 20 patients with moderate-to-severe rheumatic MS before and after percutaneous transluminal mitral valvuloplasty (PTMV) [group 1; 16 patients in chronic atrial fibrillation and 4 patients in sinus rhythm]. In addition, we measured plasma concentrations of ET-1 in the peripheral venous blood samples obtained from 22 control patients (including 14 healthy volunteers in sinus rhythm [group 2] and 8 patients in chronic lone atrial fibrillation [group 3]). Plasma ET-1 concentrations were measured by solid-phase, sandwich enzyme-linked immunosorbent assay. RESULTS: The peripheral venous plasma concentrations of ET-1 were significantly higher in group 1 patients (2.46 +/- 0.90 pg/mL) than in group 2 and group 3 patients (0.74 +/- 0.42 pg/mL and 0.99 +/- 0.41 pg/mL, respectively [mean +/- SD]; p < 0.0001). However, there was no significant difference in the peripheral venous concentrations of ET-1 between group 2 and group 3 patients. In group 1 patients, the plasma ET-1 concentration in the femoral vein (2.46 +/- 0.90 pg/mL) was significantly higher than that in the right atrium (2.02 +/- 0.69 pg/mL), left atrium (2.11 +/- 0.99 pg/mL), and femoral artery (2.05 +/- 0.75 pg/mL) [p = 0.0001]. The plasma ET-1 concentration in the femoral vein was not correlated with the mean left atrial pressure (r = 0.05; p = 0.838) and mean pulmonary artery pressure (r = 0.07; p = 0.757). The plasma ET-1 concentration in the left atrium was also not correlated with the mean left atrial pressure (r = 0.11; p = 0.656), mean pulmonary artery pressure (r = 0.06; p = 0.788), or mitral valve area (r = 0.02; p = 0.936). Although the area of mitral valve increased significantly (1.06 +/- 0.17 cm(2) vs 1.48 +/- 0.32 cm(2); p < 0.0001), and the mean left atrial pressure (23.0 +/- 5.1 mm Hg vs 17.6 +/- 5.9 mm Hg; p < 0.0001) and mean pulmonary arterial pressure (31.0 +/- 7.9 mm Hg vs 25.5 +/- 7.0 mm Hg; p < 0.001) fell significantly and immediately after PTMV, there were no significant changes in the plasma ET-1 concentrations in the femoral vein, right atrium, left atrium, and femoral artery immediately after PTMV. CONCLUSION: Increased production of ET-1 in the pulmonary circulation in response to increased pulmonary artery pressure was not the mechanism of increased circulating ET-1 concentration in patients with MS. We proposed that one of the mechanisms of increased ET-1 concentration in the femoral vein was increased peripheral ET-1 release due to increased systemic venous pressure and mechanical damage of the endothelium.     

Post-cardiac catheterization access site complications and low-molecular -weight heparin following cardiac catheterization

The low molecular weight heparin enoxaparin is often administered to patients on long-term anticoagulation regimens who temporarily discontinue warfarin prior to undergoing invasive procedures. The clinical outcome of all enoxaparin-treated patients who underwent cardiac catheterization or coronary artery interventional procedures (n = 119) was evaluated. A total of 5 patients (4.2%) requiring anticoagulation (3 with chronic atrial fibrillation and 2 with ventricular thrombi) developed severe late enoxaparin-associated hemorrhagic or vascular complications at the femoral arterial puncture site between 3 and 11 days post-procedure. Complications included development of femoral arterial pseudoaneurysm (n = 3), hypotension (systolic blood pressure < 90 mmHg) (n = 2), acute decrease in hemoglobin levels to < 8.5 mg/dl (n = 4) and cardiac arrest (n = 1). In patients receiving standard dose enoxaparin after percutaneous invasive cardiac procedures, there is the potential for delayed and severe access site hemorrhagic and vascular complications.     

Cardiac catheterization during anticoagulant therapy

Sixty-three patients receiving anticoagulant therapy with sodium warfarin underwent cardiac catheterization with prothrombin-proconvertin values between 4 and 30 percent. The anticoagulant dose was omitted the day before and resumed the evening of catheterization. Procedures included 43 right heart studies by venous cutdown, 26 transseptal left heart catheterizations, 42 percutaneous retrograde femoral arterial catheterizations, 8 transthoracic cardiac punctures and 55 percutaneous brachial arterial catheterizations.

In 1 patient left hemothorax developed after transthoracic cardiac puncture. In a second minor bleeding from the femoral arterial puncture site occurred after premature ambulation. No extensive bleeding or difficulty in obtaining hemostasis occurred. Cardiac catheterization can be performed with reasonable safety during anticoagulant therapy with the prothrombin-proconvertin time in the therapeutic range. Problems in reestablishing anticoagulant control are avoided, and the patient is not exposed to the increased risk of thromboembolic complications incurred with interrupted therapy.     

心导管术后经皮动脉血管封堵器的临床应用

目的比较经皮冠状动脉介入术后,股动脉穿刺口采用Angio-Seal血管封堵器与局部人工压迫止血方法的疗效与安全性。方法196例进行心导管检查的患者,随机分为股动脉穿刺口人工压迫止血组(82例,其中冠状动脉造影术36例,冠状动脉成形术46例)和血管封堵器止血组(114例,其中冠状动脉造影术52例,冠状动脉成形术62例),观察止血时间、并发症及成功率。结果Angio-Seal血管封堵器与局部人工压迫止血法比较,止血时间明显缩短,并发症减少,成功率相当。结论Angio-Seal血管封堵器在掌握好适应证的前提下,可广泛应用于经皮冠状动脉手术后股动脉穿刺口的处理。     

Effects of nifedipine on hepatic venous pressure gradient and portal vein blood flow in patients with cirrhosis

Abstract We investigated the effects of nifedipine on splanchnic haemodynamics in 13 patients with cirrhosis and portal hypertension, and in 10 control subjects using hepatic venous catheterization and pulsed Doppler ultrasound. There were no significant changes in systemic or splanchnic haemodynamics in control patients. In contrast, systemic vascodilatation, evidenced by significant decreases in mean arterial pressure and systemic vascular resistance, was observed in patients 20 min after sublingual application of 10 mg nifedipine. Moreover, hepatic venous pressure gradient and portal vein blood flow significantly increased after nifedipine administration. There was a significant correlation between the percentage increases in portal vein blood flow and in hepatic venous pressure gradient. However, no correlation was found between the percentage change in cardiac output and that in portal vein blood flow. Thus the increase in portal vein blood flow appears to be related to splanchnic arterial vasodilatation by nifedipine. Consequently, nifedipine has deleterious effects on portal haemodynamics in patients with cirrhosis. As nifedipine may potentially increase the risk of variceal haemorrhage in patients with less advanced varices, this drug should be used with caution in patients with chronic liver disease.     

Vasopressin and vasopressin plus nitroglycerin for portal hypertension. Effects on systemic and splanchnic hemodynamics and coronary blood flow

We measured the coronary, systemic, and splanchnic effects of vasopressin and vasopressin plus nitroglycerin in 8 stable patients with alcoholic cirrhosis. Vasopressin (0.1-0.8 U/min) increased pressure in the hepatic vein, pulmonary artery and pulmonary capillaries. Wedged hepatic (portal) vein pressure was unchanged; the hepatic venous pressure gradient (wedged-free hepatic vein pressure) fell. Insignificant declines occurred in cardiac output, gastroesophageal collateral (azygous) blood flow, hepatic blood flow and coronary sinus (cardiac) blood flow. The addition of nitroglycerin (40-70 micrograms/min) reduced pressure in the hepatic vein, pulmonary artery and pulmonary capillaries, while increasing the hepatic venous pressure gradient. Wedged hepatic vein pressure did not change. Gastroesophageal collateral (azygous) flow increased markedly; cardiac output rose to a lesser degree. Coronary sinus and hepatic blood flow did not change. Nitroglycerin ameliorated the increases in systemic and pulmonary artery pressure produced by vasopressin but also tended to reverse the decline in the hepatic venous pressure gradient and markedly increased gastroesophageal flow. Neither drug significantly affected coronary blood flow.     

Myocardial protection via coronary sinus interventions: superior effects of arterialization compared with intermittent occlusion

It has been reported that infarct size can be reduced by several interventions, by which arterial blood is delivered retrogradely to the ischemic myocardium through the cardiac veins or alternatively the cardiac venous system is intermittently occluded. Accordingly, we studied several modalities of myocardial protection that used the cardiac venous system and compared them by means of a quantitative technique for measuring infarct size. Thus 73 anesthetized dogs with coronary arterial occlusion were randomized into the following groups: group I (n = 9), 6 hr of occlusion without any intervention; group II (n = 11), venovenous shunt (60 ml/min) to the great cardiac vein; group III (n = 11), arteriovenous shunt to the anterior interventricular vein; group IV (n = 12), high flow arteriovenous shunt to the anterior interventricular vein (60 ml/min); group V (n = 11), arteriovenous shunt to the great cardiac vein (60 ml/min); group VI (n = 10), arteriovenous shunt to the great cardiac vein (60 ml/min) combined with diastolic occlusion of the great cardiac vein; group VII (n = 9), intermittent pressure-controlled occlusion of the great cardiac vein without arterialization. The arteriovenous shunt (groups III to VI) or venovenous shunt (group II) was done by selective catheterization of the anterior interventricular vein or the great cardiac vein, advancing a catheter from the jugular vein through the right atrium and coronary sinus under fluoroscopic control. This catheter was then connected to a cannula located either in the carotid artery (groups III to VI) or in the right atrium (group II). One minute after occlusion, 99mTc-labeled albumin microspheres (8 mCi) were injected into the left atrium for the subsequent assessment of the hypoperfused zone, which is the area at risk for infarction.(ABSTRACT TRUNCATED AT 250 WORDS)     

冠状动脉介入诊疗术后两种止血方法的比较

目的:比较冠状动脉诊疗术的冠状动脉介入术（PCI）及冠状动脉造影术（CAG）后,传统压迫法与采用Angioseal缝合器止血法的制动时间和并发症发生率,为术前指导和术后护理提供依据。方法:CAG及PCI患者214例按止血方法不同分为传统压迫止血组和血管缝合组,比较两组术后制动时间和并发症的发生率。结果:采用Angioseal缝合法成功率达100%,与压迫法止血比较下肢制动时间不论单纯CAG还是PCI均显著缩短（P<0.01）,缝合法术后并发症的发生率如渗血、局部血肿、迟发出血（第3天以后,至1周）、心迷走反射等显著低于传统压迫止血组（P<0.01）。结论:Angioseal缝合器止血较传统压迫止血护理操作简便,安全性高,并发症少。     

Early deambulation following cardiac catheterization by the use of 6 Fr Angio-Seal, a new hemostatic percutaneous puncture closure device]

INTRODUCTION AND OBJECTIVES: Efficacy of the hemostatic puncture closure 8 Fr Angio-Seal device for percutaneous puncture closure after a catheterism has been previously demonstrated, but the experience provided has been obtained with 8 Fr devices. At present the device has been modified and its size reduced to 6 Fr. In this pilot study we evaluate the efficacy of the new hemostatic 6 Fr Angio-Seal device and its safety when early deambulation post-diagnostic and/or therapeutic catheterization is established. PATIENTS AND METHODS: Prospective study of 150 consecutive patients randomized either for application of the 6 Fr Angio-Seal device (group A; n = 75), in which early ambulation was indicated, or manual compression (group B; n = 75), with ambulation 12 h after cardiac catheterization. Basal data, including clinical and angiographic characteristics and previous treatment with heparin and platelet aggregation inhibitors were similar in both groups. RESULTS: The time of hemostasia was significantly shorter in group A than in group B (118 +/- 210 s in A vs 1320 +/- 370 s in B; p (3/4) 0,001), and with early ambulation (3,1 +/- 0,4 h in A vs 12,3 +/- 3,1 h in B; p (3/4) 0,001) no local complications were observed. CONCLUSIONS: The 6 Fr Angio-Seal hemostatic device diminished the hemostasia time and early ambulation could be achieved. In this pilot study no complications due to early movilization were observed, but the safety of the new hemostatic device after diagnostic or therapeutic catheterizations needs to be evaluated in greater series.     

Thrombin-antithrombin complex and the prothrombin fragment in arterial and venous blood of patients with peripheral arterial disease

BACKGROUND: Thrombin generation has recently been recognized as an important factor in the development of arterial occlusive disease in all vascular provinces. Several reports concerning markers of thrombin generation have been published with however, conflicting results. It has been demonstrated in vitro that accelerated blood flow velocity causes increased thrombin generation via higher shear rates. In recent articles TAT and F1 + F2 concentrations are reported significantly higher in arterial than in venous blood. A correlation with the severity of atherosclerosis or specially with the stage of PAD was expected. In the present investigation we additionally collected blood from the femoral vein. PATIENTS AND METHODS: In 11 patients with Fontaine stages IIb to IV and two healthy subjects TAT and F1 + F2 concentrations were determined in blood samples from the femoral artery, the femoral vein (diseased leg) and cubital vein. In all cases and at all puncture sites exactly the same atraumatic technique of venipuncture was used. RESULTS: The concentrations of TAT and F1 + F2 were significantly elevated in patients with PAD. There was no significant difference between the concentrations of TAT and F1 + F2 in arterial (femoral artery) and venous (femoral vein and cubital vein) blood. CONCLUSION: The results from previous investigations have been confirmed only partially. Differences in the puncture techniques to collect arterial or venous blood result in an increased scattering of the data and a systematic error.     

Mobilization Within Thirty Minutes of Elective Diagnostic Coronary Angiography: A Feasibility Study Using a Hemostatic Femoral Puncture Closure Device

The standard procedure for obtaining hemostasis following coronary angiography is manual or mechanical compression of the femoral artery followed by 4–6 hours supine rest. The patient is then mobilized and later discharged. This consumes time and resources and may be uncomfortable for the patient. The aim of this pilot study was to determine if the Angio-Seal^TM hemostatic puncture closure device (the Angio-Seal device) allows safe, early mobilization of patients undergoing elective coronary angiography. Selected patients were randomly allocated to the the Angio-Seal device (study group, n = 24) or standard compression techniques (control group, n = 26) after completion of the diagnostic coronary angiogram. Study group patients were mobilized 25–30 minutes after sheath removal and deployment of the Angio-Seal device. After hemostasis in control patients, a pressure bandage was applied, and the patient was placed on bed rest for 4–6 hours. There was no age or sex difference between the study group and the control group. There were more patients with hypertension, diabetes mellitus, or obesity in the control group. Time to hemostasis was 0.5 ± 1.4 min for the study group and 42.9 ± 20.6 min for the control group (P < 0.0001). Time to mobilization was 32.5 ± 6.9 min for the study group and 322.7 ± 41.8 for the control group (P < 0.0001), with 83% and 92% (P = NS) of patients in respective groups being fully mobilized according to protocol. Complications requiring clinical intervention were seen in three patients (12.5%) in the study group and in one patient (4%) in the control group. We have shown that mobilization of patients within 30 minutes of diagnostic coronary angiography via the femoral artery is feasible using the Angio-Seal device. The safety of this approach needs to be addressed in a larger randomized study.